Friedel Godehard, Kuipers Thomas, Engel Corinna, Schopf Christine, Veit Stefanie, Zoller Jutta, Kyriss Thomas, Greulich Michael, Toomes Heikki
Department of Thoracic Surgery, Schillerhöhe Hospital, Gerlingen, Germany.
Thorac Surg Sci. 2005 Aug 22;2:Doc01.
In spite of available recommendations, therapeutic procedures of locally recurrent breast cancer are very different. In a retrospective study, the possibilities and results of complete, full-thickness chest wall resection are presented.
Between 1985 and 2004, 51 women underwent complete, full-thickness chest wall resection with primary coverage. Primary surgical therapy of breast cancer had been mastectomy in 88%. Median age of patients undergoing surgery for a local recurrence was 57 (29 - 81) years. The median interval between surgery of the primary tumour and of the local recurrence was 70.3 (10.7 - 327.2) months; median follow-up was 29.4 (1.8 - 230.9) months. 40 (78.4%) patients required rib resections, 15 (29.4%) of them in combination with partial sternal resection. In 4 (7.8%) patients complete and in 7 (13.7%) patients partial sternal resection without additional rib resection were performed.Coverage was mainly realized using latissimus dorsi myocutaneous flaps (n=44; 86.3%). Survival rates were calculated by means of the Kaplan-Meier method, the relative risk using univariate and multivariate Cox-regression analysis.
In the total collective, cumulative 5-, 10- and 15-year survival (YS) rates were 39%, 31% and 23%, respectively, median survival 46.4 months. R0 resection was associated with a 5-YS of 42%. Prognostic factors were age at the time of primary surgery, disease-free interval and tumour invasion of bony structures. Mortality was 2%, morbidity 35%.
Full-thickness chest wall resection of locally recurrent breast cancer is possible in almost any patient when performed by a team of thoracic and plastic surgeons. Only radical resection provides good long-term results with low mortality and morbidity.
尽管有可用的建议，但局部复发性乳腺癌的治疗方法差异很大。在一项回顾性研究中，介绍了完整全层胸壁切除的可能性和结果。
1985年至2004年间，51名女性接受了带一期覆盖的完整全层胸壁切除。88%的乳腺癌一期手术治疗为乳房切除术。局部复发接受手术患者的中位年龄为57（29 - 81）岁。原发肿瘤手术与局部复发手术之间的中位间隔为70.3（10.7 - 327.2）个月；中位随访时间为29.4（1.8 - 230.9）个月。40例（78.4%）患者需要切除肋骨，其中15例（29.4%）同时进行部分胸骨切除。4例（7.8%）患者进行了完整胸骨切除，7例（13.7%）患者进行了无额外肋骨切除的部分胸骨切除。覆盖主要采用背阔肌肌皮瓣（n = 44；86.3%）。生存率采用Kaplan-Meier法计算，相对风险采用单因素和多因素Cox回归分析。
在整个队列中，5年、10年和15年累积生存率分别为39%、31%和23%，中位生存期为46.4个月。R0切除与5年生存率42%相关。预后因素为初次手术时的年龄、无病间期和骨结构的肿瘤侵犯。死亡率为2%，发病率为35%。
对于几乎所有患者，由胸外科和整形外科医生团队进行局部复发性乳腺癌的全层胸壁切除都是可行的。只有根治性切除才能提供低死亡率和发病率的良好长期效果。
